Accuracy of CT Staging of Locally Advanced Gastric Cancer after Neoadjuvant Chemotherapy: Cohort Evaluation within a Randomized Phase II Study
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Accuracy of the radiologic diagnosis of gastric cancer staging after neoadjuvant chemotherapy remains unclear.
Patients enrolled in the COMPASS trial, a randomized phase II study comparing two and four courses of S-1 plus cisplatin and paclitaxel and cisplatin followed by gastrectomy, were examined. The radiologic stage was determined by using thin-slice computed tomography (CT) or multidetector low CT by following Habermann’s method.
A total of 75 patients registered in the COMPASS study who underwent surgical resection were examined in this study. The radiologic T and pathologic T stages were not significantly correlated (p = 0.221). The radiologic accuracy and rates of underdiagnosis and overdiagnosis were 42.7, 10.7, and 46.7%, respectively. When patients were stratified according to the pathologic response of the primary tumor, the correlation was not significant in either the responders (n = 32, p = 0.410) or the nonresponders (n = 43, p = 0.742). The radiologic accuracy was 37.5% in the responders and 42.7% in the nonresponders. The radiologic N and pathologic N stages were significantly correlated (p = 0.000). The radiologic accuracy and rates of underdiagnosis and overdiagnosis were 44, 29.3, and 26.7%, respectively. When stratifying the patients with measurable lymph nodes according only to the radiologic response, the correlation was significant in the nonresponders (n = 23, p = 0.035) but not in the responders (n = 28, p = 0.634). The radiologic accuracy was 39.3% in the responders and 52.1% in the nonresponders.
Restaging using CT after neoadjuvant chemotherapy for gastric cancer is considered to be inaccurate and unreliable. In particular, the radiologic T-staging determined after neoadjuvant chemotherapy should not be considered in clinical decision-making.
KeywordsGastric Cancer Paclitaxel Pathologic Response Peritoneal Metastasis Radiologic Response
This work was supported by the Epidemiological & Clinical Research Information Network (ECRIN).
- 7.National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology. Gastric Cancer Version 2.2011. http://www.nccn.org/professionals/physician_gls/pdf/gastric.pdf. Accessed 25 Apr 2013.
- 14.Yoshikawa T, Tsuburaya A, Morita S, et al. A comparison of multimodality treatment: two or four courses of paclitaxel plus cisplatin or S-1 plus cisplatin followed by surgery for locally advanced gastric cancer, a randomized phase II trial (COMPASS). Jpn J Clin Oncol. 2010;40:369–72.PubMedCrossRefGoogle Scholar
- 21.Sobin LH, Gospodarowicz MK, Witterkind CH. International Union against Cancer (UICC) TNM classification of malignant tumors. 7th ed. Oxford, UK: Wiley-Blackwell; 2009.Google Scholar
- 22.Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000;92:205–16.PubMedCrossRefGoogle Scholar